Healthcare Provider Details

I. General information

NPI: 1033865258
Provider Name (Legal Business Name): MICHAEL ALONSO RAMIREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W D. L. INGRAM AVE, CANNON AFB, NM 88101
CANNON AFB NM
88101
US

IV. Provider business mailing address

104 W D. L. INGRAM AVE
CANNON AIR FORCE BASE NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-2778
  • Fax:
Mailing address:
  • Phone: 575-784-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101284121
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101284121
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: